Laserfiche WebLink
man <br /> PERMIT APPLICATIO <br /> ILI <br /> BUILDIN ECHANICAL/PLUMBING/SIGN RIP RINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASItINGTON (P)425-257-8810 J FAX 425-257-8857 j(E)everetteps@everettwa.gov j www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: `$ , V 1 V't PROPERTY TAX#:W4-11.D)Celapcyl.CX <br /> LEGAL for new construction: Short Platlsubdivision t No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME} (; (J Tod ion f ( * TENANT BUSINESS NAME(Commercial):C Qs(`(`tdn �(t� ' ,e, <br /> OWNER MAILING ADDRESS: srrer_r 1 t S. `elf '•"w`�, 1"Ye� `~-" <br /> CITY ' `1V"—.!"�.�`TT STATE I AZNi zP q k <br /> OWNER PHONE:L4 3 5-1 3 net OWNER EMAIL:J e (ek.5,1`t1ot,JA t ti p <br /> CONTRACTOR NAME: L; . V\ - t k r"'WA <br /> ` tC_omCONTRACTOR ADDRESS: STREET O -�' Q <br /> \ \( o `! '•A V- O <br /> CITY F-IR ‘esorniSYI STATE (}31211 ZIP q 0 <br /> CONTRACTOR PHONE: Z 4 CONTRACTOR EMAIL:( ', ��Vy1..;1-h'(Y , tke.(0 n. <br /> CONTRACTOR LICENSE#(REQUIRED): M f � CITY OF EVERETT BUSINESS UCENSE#(REQUIRED)1O'09-1945 <br /> PRIMARY CONTACT: D OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT` / NAME: ' etc--� or CONTACT PHONE:E.4 a 5 — Li <br /> �[ C t e'(,01/46 rS CONTACT EMAIL: Sx,l 00 k t` j• co,y, <br /> BUILDING INFORMATION <br /> Existing Use of Building: �(e l oece'LAr AI Contract Price of Work:$ L 1 (aLl-I , <br /> tRiProposed Use of Building: -c�-e - � y 1 c Heat Source: 'Gas DElectric ©Other <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex DADU ❑Mult1 amity-#Units: Commercial DAccessory Structure <br /> Type of Project: ONew ❑Addition ❑RemodeljRepair ❑T.1. ❑Sign [Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:i ,v „^ \‘ o Qcepe o - to top, c'Oec op ti - -- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Gaunt Count Count <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower.Tub.or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> r)e° Forced Air Systems t Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the infomiation contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal.state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building 0 "/a/before being authorized under any circumstance.I am the owner,or t am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 c pi with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �/�-�� "I 5)\, 1 Cyr) PERK — � ciao <br /> 1wner uthorized Agent ignature Date (Revised 10110/2018) <br /> 1/Z <br />